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New Horizons in Health - From vision to practice

Spencer Hagard

Internet Publication: 21 August, 1998

Presented to the XVI WORLD CONFERENCE on HEALTH PROMOTION AND HEALTH EDUCATION, OPENING CEREMONY, San Juan, Puerto Rico, Sunday 21 June 1998

The subject for this presentation - new horizons in health, from vision to practice - raises for me three questions:

First, what may be the new horizons in health?

Second, do we share a common vision of health?

Third, what practices are most needed to make realities of our vision?

I shall briefly address all three questions, not attempting to cover all the issues they raise.

I do not imagine that anything I am going to say in the next few minutes - in response to these questions - will be new or surprising to most of the people in this room, familiar as we are with the precepts of HFA2OOO and the Ottawa Charter, re-animated by the Jakarta Declaration and Health for All in the 21" Century.

Let me start by asking "what may be the new horizons in health?". We may respond, either by once again looking optimistically in a direction that has motivated the whole of our careers in health promotion and health education, or we may stare at a prospect which is uncomfortable to think about. But we have to think about it, for if we do not, we are likely to help create it by our negligence or impotence.

This prospect, which has animated us with such concern over the past decades, is of a world of apparently greater personal freedom and opportunity for many people - good news indeed - but not at the unacceptable cost which it threatens. In such a world, the privileged minorities across the globe already enjoy apparently greater health and well-being, while billions of their fellow human beings continue to live in seemingly endless distress and suffering, the burden of their lives relieved only by premature death. We know - and we remind each other in our daily work and in our literature - that greater health and well-being for some, at the expense of others, is not only morally unacceptable, but is ultimately an illusion. We recognise that inequality and social exclusion damage not only those at the bottom of the human heap, but everyone in human society.

Well, however much that is true, and however little we need further convincing, by what are old truths after all, however brilliantly re-illuminated by contemporary research, we must also ask ourselves who else is listening to what we hold to be true? Who, among the handful of elite bodies which make the economic policies of our world, who among the politicians and their advisers, many of whom are so busily axing policies of social solidarity in so many societies? Let us not forget that most of these decision makers take their actions in the name of social progress, and a better future for humanity, which we also proclaim. But, who among these decision makers is heeding what we consider to be universal truths about human aspirations for health and well-being, and how we think these aspirations are best achieved?

If we think they are not listening - and that is what most of us think - and if we cannot stomach what we see happening to the health and well-being of the people in so many societies, as a result of current economic and social policies, we can either look forward to a dialogue of the deaf, or we shall need to engage them in our thinking, persuade them of our arguments. We shall need to communicate a vision of health which responds to the predominant agenda, which is able to capture the imagination, and motivate the actions, of many more people outside ‘our club’ than are within it, which is able to influence policy makers and move decision makers, who have never considered, and will never consider themselves part of the health movement. We have an alternative - it is tempting - to subsist on cynicism, to question motives, to comment without engaging. For me, that would be a demeaning of our purposes, and a terrible betrayal of the health of the peoples of the World.

The challenge of engagement with the powerful forces which move billions of lives, is one of the prime factors that makes working in contemporary health promotion exciting for me, and lights up my enthusiasm for a conference - such as this - which chooses 'equity, empowerment, environment and economy' as its main themes.

So, what vision of health can we offer the World's great movers and shakers? It is of course no different in essence from the vision we pursue in our own work, at all levels of society across the world. No different, in essence, from the vision of the school health educator in Uganda or Malaysia, the healthy city co-ordinator in Lithuania or New Zealand, the community health worker in Chile or India. We all share a vision of individuals and communities achieving the greatest possible level of health and well-being, by increasing their control of the very factors which determine their health and well-being. The achievement of this vision is articulated through the fundamental conditions for health detailed in the Ottawa Charter and Health for All, and in the Charter's action areas and means, which are intended to activate our efforts.

This is a vision to which I am sure we will wish to hold fast. These are means which I am sure we will wish to apply and refine through the benefits of research and the experience of practice. But to make our vision a fully realisable, practical reality will require actions on the part of others, others for whom this is not the primary vision which shapes their world and drives their decisions - the Ministries of Finance and Economy, of Industry and Agriculture, the highway engineering companies and the motor manufacturers, the tourism sector and the educationists. If the modern world has brought problems of unregulated, economic liberalism, then in its wake have come opportunities that we must recognise and seize. If the governance of society is so strongly directed towards economic ends, ours is the opportunity to demonstrate convincingly and advocate effectively that these ends are best achieved when our vision of health is pursued - our vision which values people, and values their means to health and well-being, as much as the end itself. In other words, to what we already do well, and strive every day to do better, we urgently need to add an extra dimension. That dimension is the effective description, advocacy and support of investment for health through the main economic and social development priorities of all of our societies.

What would this mean for us in practice, indeed what does it already mean in societies where it is beginning to happen? First, that we have to be able to demonstrate that our theories are realistic and coherent, that our methods are effective, that our practices are sound, that our personnel are fully educated, trained and continually updated. Those are our prerequisites for being taken seriously in the first place. But, second, to move the great levers of the modern world, we need to strongly direct our attention to those who formulate and implement the World's social and economic policies. That especially means directing our efforts to governments, to intergovernmental bodies, to industry and to commerce. These are being spoken of as the new partners for health. In my opinion, they are only potentially so. I think, that if they are truly to become so, it will take the combined strength of all the old partners for health, and of the allied social and environmental movements, which have generally shown rather greater resourcefulness, and practical initiative, in managing the world of power, than we have in health!

We are privileged to be here in San Juan, and we warmly thank our hosts for all their selfless preparations for this huge event. May we all enjoy the next few days, learn from one another and, above all, go back to our homelands and our workplaces having learnt a great deal more about turning our noble vision into effective practice, and the part we can each of us play to do so.

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